title: Food bolus impaction secondary to reflux strictures: a rural surgical experience.
abstract: BACKGROUND
  Benign esophageal strictures at the gastroesophageal (GE) junction secondary to acid reflux have an unknown altered natural history after dilation.
  
  
  METHODS
  We carried out a 7-year retrospective investigation from 2001 to 2007.
  
  
  RESULTS
  Sixty-four patients presented with food bolus impaction at the GE junction. Reflux strictures were the cause in 42 (66%), neuromuscular disease or dysmotility in 2 (3%), esophageal cancer in 1 (2%), and no underlying pathology could be identified in 19 (29%). Duration of dilation-induced relief from impaction recurrence decreased with each subsequent dilation: first 30 +/- 21 months, second 27 +/- 15 months, and third 8 +/- 6 months. Patients taking proton pump inhibitors (PPIs) had a longer interval between dilations (25 +/- 9 months) compared with those who were not (20 +/- 12 months, p = 0.06). PPIs also decreased the number of subsequent dilations needed during the course of the study (1 +/- 1 versus 2 +/- 1 dilations, p = 0.02). Reflux strictures were more likely to cause another episode of impaction than no underlying pathology (relative risk, 2.7; 95% CI, 1.8-4.1; p < 0.0001). Mean followup was 38 months (range 2 to 120 months).
  
  
  CONCLUSIONS
  Reflux strictures are well treated with dilation and PPIs. Although food bolus impaction can occur without an underlying pathology, patients with relux strictures are likely to have a recurrence and should be treated aggressively. Addition of PPIs appears to decrease the number of dilations that a patient will require and lengthen the interval between dilations. Patients requiring more than two dilations after initiation of PPI therapy are unlikely to have durable relief.
authors.affiliation: Passavant Surgical Associates, Jacksonville, IL 62650, USA. heartandbones@yahoo.com
authors.forename: John Alfred
authors.initials: JA
authors.lastname: Carr
authors.forename: James A
authors.initials: JA
authors.lastname: Drennan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004106:Dilatation; D004636:Emergency Service, Hospital; D004940:Esophageal Stenosis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D004943:Esophagogastric Junction; D005260:Female; D005502:Food; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000473:pathology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D019035:Rural Health Services